The Research of Service Design Based on Activity Theory: Focusing on the Process of Telehealthcare Services Promotion Yen-Hung Kuo a Ssu-Pei Cheng b Y

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1 第十七卷第三期 2015 年 9 月 (pp.315~344) a b c d, e, * f, g a b c d e f g * lschen@kmu.edu.tw DOI: /JEB (3).02 September

2 The Research of Service Design Based on Activity Theory: Focusing on the Process of Telehealthcare Services Promotion Yen-Hung Kuo a Ssu-Pei Cheng b Yi-Kuang Chien c Lin-Sui Chen d, e Ching-Kuan Liu f, g a Department of Hospital and Health Care Administration, Chia-Nan University of Pharmacy and Science b Division of Medical Quality Control, Kaohsiung Medical University Chung-Ho Memorial Hospital c Center for Community Health Care, Kaohsiung Medical University Chung-Ho Memorial Hospital d Division of Planning and Management, Kaohsiung Medical University Chung-Ho Memorial Hospital e Department of Business Management: Doctoral Program, National Sun Tat-sen University f Department of Neurosurgery, Kaohsiung Medical University Chung-Ho Memorial Hospital g Department of Neurosurgery, Kaohsiung Medical University Abstract Nowadays, health care seeking behaviors have no longer been restricted their performing in healthcare organizations. This reflects the paradigm shift of health care service delivery model from the perspective of patriarchy on medicine to the patient centered. From the social-cultural perspective, this research aimed on examining the consequences of contradictionaries with the lack of considering cultural embeddeness in the innovative service design process. With the case research focuses on the process of telehealthcare service promotion in a medical center in southern Taiwan, we revealed several insights related to the innovative service design. Based on the Ethnography, we applied activity theory to construct the activity systems of the telehealthcare service promotion from a total of 35 experienced service promotion processes. Furthermore, several contradictionaries were extracted through the activity system in the research. Finally, we provide several suggestions for the future healthcare industry to enhance the understanding of IT-enabled services design with cultural embeddedness. Keywords: Activity Theory, contextual inquiry, telehealthcare, service design, healthcare seeking behavior 316 September 2015

3 研究背景與動機 2007 Commercialization Commodification Stoeckle, Telehealthcare 研究目的 September

4 (1) (2) (3) 遠距健康照護服務 2008 Kuo et al., 2012 Dakins, (1) (2) (3) 318 September 2015

5 2.2 商品化下的遠距健康照護服務社會脈絡 Kuo et al, 2012 September

6 2.3 活動理論 Leont ev 1981 Engeström 1987 Kuutti 1991 Roth 2007 Activity Theory AT Vygotsky Cultural- History Theory Roth and Lee, Wertsch, 1985 Vygotsky 1978 Subject Tool Object Objectorientedness Action Nardi et al., 1998 Vygotsky 1978 Vygotsky Engeström September 2015

7 Tool Rules Division of labor Contradiction Engeström, 研究場域與研究對象 (1) ICT Kuo et al., 2012 (2) 1 1 September

8 研究設計與流程 Ethnography Fetterman, 2010 Gray, 2003 (1) Participant observation Jorgensen, 1989 Field notes (2) (3) 322 September 2015

9 Engeström, 2000 Kaptelinin et al., 1999 Kaptelinin et al September

10 1 場域觀察階段脈絡探索階段 ( n=35 ) ( n=26 ) 1. 研究計畫擬定 5. 擬定訪談計畫田野筆記家訪觀察病房收案觀察 2. 參與觀察 3. 服務推廣活動系統繪製 6. 確認訪談對象 7. 進行訪談願意購買不願意購買 4. 矛盾探索 8. 訪談文本編碼分析 9. 服務推廣活動系統繪製與矛盾分析 10. 活動模型繪製服務設計診斷結論與建議服務設計階段資料分析 September 2015

11 N Y M D S W H N TE OR IR Engeström 2000 Meta-code Kuutti, 1996 Engeström 2000 September

12 Benyon, 2010 Flow Model Sequence Model Artifact Model Cultural Model Physical Model 326 September 2015

13 3.3.4 Lincoln and Guba 1985 Dependability Credibility Transferability (1) (2) 1 (3) September

14 4. 2 (1) (2) (3) 工具自費醫療服務主體護理師目標病患與家屬在需求不明下做決定規則 (1) 外勤護理師主動推銷 (2) 病患與家屬有自由購買權 (3) 商品化醫療意象社群住院病房分工 (1) 病患與家屬是外勤護理師推銷的對象 (2) 個案管理師出院準備服組篩選潛客 (3) 醫師異於常規治療計劃之活動 September 2015

15 NW1A06: YS7A12: b YW13A10: September

16 YM14A03:6-3 ND6A20:2-1 YM11A09:6-1 YD12A08: September 2015

17 1993 Benyon, 有缺漏的自費推銷活動經驗 1993 NM18A05:4-3 NM15A03:2-1 September

18 進行篩選及轉介出院準備服務組住院資訊系統 - 病患就醫住院相關資料整合下達醫囑病患相關資料置入醫師 - 看診 - 安排醫療治療照護計劃 - 篩選及轉介病患 - 通知轉介完成進行篩選及轉介下達醫囑通知轉介完成護理站個案管理師住院病房住院病患與家屬看診 - 病患住院相關事宜 - 篩選及轉介病患 - 通知轉介完成通知轉介完成進行服務推廣辦理出院掛號外勤護理師 - 接收轉介完成訊息 - 進行潛客收案活動掛號 / 批價櫃臺 - 負責病患掛號 / 批價事宜 3 進行看診活動門診區 - 各科別診療室門診區候診 332 September 2015

19 1990 YS7A11:4-1 NM15A07: a YD12A03:4-3 September

20 N1A06-1: N1A09-2: N1A05-1:4-1 Benyon, September 2015

21 4 託付式順從醫病文化常規治療計劃病患治療照護計劃加入醫師參與醫師安排醫療照護服務病患與家屬推銷方式推銷意味的服務推廣商品化醫療照護服務置入自費服務與商品為難的服務訊息傳遞 1998a (1) September

22 YD12A07:3-1 NW1A18:3-1 (2) N1A11:1-1 YD4A16:3-1 ND8A22:3-1 NM15A06:3-1 NM19A04:3-1 Benyon, September 2015

23 5 5. Cultural Tool 2011 September

24 推廣流程表明身份遠距健康照護服務介紹服務組合說明評估病患與家屬意願危險線前臺病患與家屬反應流程言語表達冷淡 Face sign 心不在焉 Face sign 熱絡的發問 Face sign? 草率表態拒絕回應 Face sign ~ 詳談自費價錢及內容問題 Face sign 急忙的再次回絕 Face sign 言語表達積極 Face sign 熱切回應會聯絡 Face sign 可視線後臺推廣呈現陌生感認知評估自身狀況衡量服務效益依認知程度進行決策表現相異的感受回應衡量自身疾病狀況是否需要自費服務對於疾病照護的實質幫助依據理解程度及服務對於照護的實際幫助進行決策 September 2015

25 5.1 針對異於常規治療計劃之活動的診斷建議 (1) 2013 (2) 5.2 針對有缺漏的自費推銷活動經驗的診斷建議 1993 (1) Bottom up September

26 (2) 5.3 針對為難的服務訊息傳遞的診斷建議 (1) (2) (3) September 2015

27 Leonardi, September

28 &menu_ id 40&news_id a b September 2015

29 Benyon, D. (2010). Designing interactive systems: a comprehensive to HCI and interaction design. England: Pearson Education Limited. Dakins, M. E. (1999). The value of the value of information. Human and Ecological Risk Assessmen, 5(2), Engeström, Y. (1987). An activity-theoretical approach to developmental research. Helsinki: Orienta-Konsultit. Engeström, Y. (2000). Activity theory as a framework for analyzing and redesigning work. Ergonomics, 43(7): Fetterman, D. M. (2010). Ethnography: Step by Step (3rd edition). Thousand Oaks, CA: Sage. Grary, A. (2003). Research practice for cultural studies: ethnographic methods and lived cultures. London: SAGE. Jorgensen, D. L. (1989). Participant Observation: A Methodology for Human Studies. Newbury Park, CA: SAGE. Kaptelinin, V., Nardi, B., & Macaulay, C. (1999). The activity checklist: A tool for repre- September

30 senting the pace of context of context. Interactions 6(4), Kuo, Y. H., Chien, Y. K., Wang, W. R., Chen, C. H., Chen, L. S., & Liu, C. K. (2012). Development of a home-based telehealthcare model for improving the effectiveness of the chronic care of stroke patients. The Kaohsiung journal of medical sciences, 28(1), Kuutti, K. (1991). Activity theory and its applications to information systems research and development. In Nissen, H. E., Klein, H. K. & Hirscheim, R. (Eds.), Information systems research: contemporary approaches and emergent traditions, ( ). Amsterdam: Elsevier. Kuutti, K. (1996). Activity theory as a potential framework for human-computer interaction research. In Nardi, B. A. (Ed.), Context and consciousness: activity theory and human-computer interaction. Cambridge, Massachusetts: MIT Press. Leont ev, A. N. (1981). The problem of activity in psychology. Armonk, New York: Sharpe. Leonardi, P. M. (2011). When flexible routines meet flexible technologies: affordance, constraint, and the imbrication of human and material agencies. MIS Quarterly, 35(1), Lincolin, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hill, CA: Sage. Nardi, B. A, Miller, J. R., & Wright, D. J. (1998). Collaborative, programmable intelligent agents. Communications of the ACM, 41(3), Roth, W. M., & Lee, Y. J. (2007). Vygotsky s neglected legacy: cultural-historical activity theory. Review of Educational Research, 2(77), Stoeckle, D. J. (2000). From service to commodity: corporization, competition, commodification, and customer culture transforms health care. Croatian Medical Journal, 41, Vygotsky, L. (1978). Interaction between learning and development. MA: Harvard University Press. Wertsch, J. V. (1985). Vygotsky and the social formation of mind. MA: Harvard University Press. 344 September 2015

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Microsoft Word - 10100000191.doc 臺灣集中保管結算所股份有限公司辦理認購 ( 售 ) 權證帳簿劃撥作業配合事項部分條文修正條文對照表附件 1 修正條文現行條文說明第五章認購 ( 售 ) 權證之權利行使第一節認購權證採證券給付或以證券給付之認購權證發行人得選